# LAKEWOOD FAMILY DENTAL OF KOKOMO PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346738556
- **Authorized official:** DR. SRINIVASULU KAKOLLU DDS (PRESIDENT)
- **Authorized official phone:** (732) 379-0953

## Contact information

- **Practice address:** 2302 S DIXON RD STE 125, KOKOMO, IN 46902-6429
- **Practice address phone:** (732) 379-0953
- **Mailing address:** 8777 PURDUE RD STE 115, INDIANAPOLIS, IN 46268-3104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2018
- **Last updated:** 04/24/2018